ED Coding and Reimbursement Alert

Question: Encounter notes indicate that the ED physician inserted a peripherally inserted central venous catheter (PICC). How should I report this encounter?

Massachusetts Subscriber

Answer: You’re going to need more information in order to choose the correct CPT® code for this procedure. Go back and look at the notes, and try to answer these questions:

• What was the age of the patient?
• Did the physician use imaging guidance?

Then, you can choose one of the following codes, depending on encounter specifics:

• 36568 (Insertion of peripherally inserted central venous catheter (PICC), without subcutaneous port or pump, without imaging guidance; younger than 5 years of age)
• 36569 (… age 5 years or older)
• 36572 (Insertion of peripherally inserted central venous catheter (PICC), without subcutaneous port or pump, including all imaging guidance, image documentation, and all associated radiological supervision and interpretation required to perform the insertion; younger than 5 years of age)
• 36573 (… age 5 years or older)

Remember: Since there are codes you can use that include guidance, you should never report any of the above codes with +76937 (Ultrasound guidance for vascular access requiring ultrasound evaluation of potential access sites, documentation of selected vessel patency, concurrent real-time ultrasound visualization of vascular needle entry, with permanent recording and reporting (List separately in addition to code for primary procedure)) or +77001 (Fluoroscopic guidance for central venous access device placement, replacement (catheter only or complete), or removal (includes fluoroscopic guidance for vascular access and catheter manipulation, any necessary contrast injections through access site or catheter with related venography radiologic supervision and interpretation, and radiographic documentation of final catheter position) (List separately in addition to code for primary procedure)).